‘Burnout levels are increasing, and disaffection is a big problem within the industry'

At a recent event organised by Practice Plan, Principal Dentist and CEO of Psynergy Mental Health, Ritesh Aggrawal, delivered a session on stress, mental resilience and how to build a mentally healthy workplace culture for dental practices. Practice Plan Regional Support Manager, Josie Hutchings, caught up with him afterwards to find out more about his views on the mental health landscape within dentistry.

JH How would you describe the mental health and wellbeing of the profession as you see it today, Ritesh?

RA Unfortunately, pretty poor. There's a huge amount of stress. Burnout levels are increasing, and disaffection is a big problem within the industry. There are also other problems we don't really talk about such as compassion fatigue.

If our mental health is poor, we can become depersonalised. We lose our capacity to be empathetic towards patients. That's something we've seen in secondary care work, but I think it is also now happening in primary care amongst the dental profession.

So, to sum up, I think the state of mental health within the profession is poor. However, on a more optimistic note, because we talk more about mental health and wellbeing, I feel that, hopefully, more action will start to be taken.

JH Just picking up on your point about compassion fatigue, do you think it's got worse since COVID-19?

RA Yes, I do. Poor mental health is a perpetual cycle. So, we start to feel mentally unhealthy, and we lose a little bit of ourselves. We become more withdrawn and isolated, which feeds the anxiety or depression we're experiencing. That then leads us to become more isolated, we possibly become a little more questioning of ourselves and can start to feel guilty or shameful. We can feel as if we're a shadow of our former self and can fixate on that. It's then hard to put yourself in someone else's shoes when they come into the practice because you have all these thoughts rattling around in your head about what's going on with yourself making it difficult to be empathetic.

COVID-19 led to us questioning a lot of things within ourselves. Many of us have looked at ourselves inwardly and asked, ‘what is our true meaning, or purpose?'. COVID-19 gets blamed for everything but it's not just the pandemic - we have transitioned out of that situation. Now we have financial stress, a cost-of-living crisis, coupled with the ever-changing landscape of NHS contracts and more people going private, creating more competition for existing private practices, which can then have a knock-on effect for them. So, it's a multifactorial situation.

We at Psynergy Mental Health are working with the Sheffield Children's Hospital to improve their culture, and I see secondary care workers losing their capacity for empathy. When that happens, patient outcomes are affected because if we lose ourselves and we're not showing empathy to our patients, their experience isn't as good as it should be and therefore their outcome is not as good as it should be. It's a real problem.

JH There are well-documented stresses across the board. What significance has mental health and wellbeing taken on as a result of these?

RA One thing is, we're talking about it more and that's a real positive that's come out of COVID. I do think we're in danger of wellbeing washing, though. There are a lot of people out there who talk a great game but deliver a very substandard one. We can't just talk; we have to take action and, in some instances, we are.

Certain companies have adopted employee assistance programmes to provide support for their staff in need, and I think that's fantastic. Let's be honest, we should have been doing this years ago. But we're doing it now, so we should be thankful for that. But I do think that more needs to be done.

If you go into any board meeting in most corporates, the first thing they will talk about is whether there are any health and safety issues, because they're obliged to, it's a statutory issue. But health and safety includes mental health and psychological safety. So, it's always been there. We just haven't equated the two.

If you want to build practices for the future, your number one priority must be to build a culture that will allow people not just to survive, but to flourish.

JH In your session you talked about reframing, or flipping the script. Could you explain the concept and why it can have a positive impact?

RA To be able to reframe things I suggest you get comfortable with failure.

A great analogy of reframing is when you learned to walk. You took a couple of steps and you fell flat on your face or backwards on your nappy. But you didn't just stop and think you couldn't walk; you just instinctively did it and tried again.

So, reframing is an important part of being able to shift your mindset from a negative mindset to a more positive one where you feel like there's going to be a positive end result. I use another analogy to do with me and golf. I'm not the best golfer in the world, but I don't just say I'm rubbish. I say I'm not the best golfer in the world, but I've watched a couple of videos or had a couple of lessons and I'm practising so I can get better at it.

So now I've got focus, that's going to help me move forward as opposed to ‘I'm just rubbish and I'm stuck there.'

It's about having an actionable step to continue going forward. It's about giving yourself hope that you can still go on. It might take a few (or even a lot) more steps to keep getting better, but it ensures there's always a forward path. So that's why reframing is so important.

JH How would you respond to someone who might consider all this a bit flippant?

RA People have to find their own way and their own path.

We all have a responsibility for our own mental health and there's only so much you can do personally. I don't believe in being flippant, because we're looking to give people direction so they can then look at practising strategies for self-care and finding their own solution that is personalised and works for them.

We cannot fix people. As dentists we are fixers, but in mental health you cannot do that. The individual has to find their own solutions. All we can do is show compassion, empathy, and support.

JH We're discussing mental health and wellbeing now more than ever before. Can you recall a watershed moment where it became okay and healthy to do so?

RA I think the watershed moment was the pandemic. We were all isolated in lockdown and this caused a real shift in focus, and we started to appreciate the importance of figuring out ways to connect with our teams.

During the lockdown from March to June 2020, we started to maintain relationships with our teams online, as we realised it was important to do that, and I think that's the biggest watershed moment I recall. Because off the back of that, a lot of people, including a lot of famous ones, started to talk openly about their mental health. We now have Dr Alex George as the UK Youth Mental Health Ambassador, so it's being taken seriously.

The pandemic caused a real shift in attitudes towards mental health and wellbeing, so I see that as a big watershed moment.

JH Everyone has their own coping mechanisms for stress and stressful situations. What tips and advice would you give based on your knowledge?

RA That's a great question Josie as it focuses on exactly what I talk about. It's about personalisation of strategies and finding ones that work for you.

I talk a lot about things like mindfulness. Meditation doesn't work for me. I struggle to free my mind, but I can go and have a four-hour round of golf and focus on just that which gives me that respite from what's happening in my practice, or my family. Mindfulness is just about being in the present, but it's crucial to find things that work for you.

It's like physical health. Some people go the gym, some jog, other people walk or cycle. They have found something that works for them. Going to the gym doesn't engage me at all, but I love playing golf, which gets me out on a walk. I like going for a walk, and that will keep me engaged long term. Because like any human being, if we do something and it doesn't give us the result we want, we drop off. If you have something that you enjoy doing that maintains that engagement, you're more likely to stick with it.

So that's the biggest tip I can give is to find something you enjoy doing.

I would also advise trying as many things as you can, and if it doesn't work, it's not a failure. It's just not right for you. It's about flipping the script and reframing. Get comfortable with that word ‘failure.'

There are plenty of self-help strategies that cost nothing. Walking and being out in nature is now a prescribed intervention by GPs for adults. Other people take cold showers as cold water therapy is becoming more popular these days. There are plenty of options out there that are free of charge. So just find something that works for you.

For more information visit the Practice Plan website www.practiceplan.co.uk/nhs

About Ritesh

Dr Ritesh Aggarwal qualified as a dentist in 1999 and he is the owner and principal dentist of Edge Dental Studio in Sheffield. He is also the MD of Psynergy Mental Health - a start-up company working to advance the way mental health is approached, assessed and treated. He is passionate about adopting new preventative approaches to mental health in the hope of reducing the chances of mental illness. By understanding mental health in greater depth, Psynergy creates personalised intervention strategies that are specific to individuals and organisations.

About Josie

Josie Hutchings has been a Regional Support Manager at Practice Plan for 22 years and has more than 30 years' experience in the dental industry. Practice Plan is the UK's leading provider of practice-branded patient membership plans, partnering with over 2,000 dental practices and offering a wide range of business support services